When you get hurt on the job, you expect your employer and their insurance company to help you recover through workers’ compensation benefits. Unfortunately, many injured workers in Louisiana are shocked to learn that their claims have been denied. This leaves them wondering whether the denial was even legal and what they can do next. At Wanko Workers’ Comp Lawyers in Thibodaux, we help Louisiana workers understand their rights and fight back when employers or insurers act unfairly.
Understanding Louisiana Workers’ Compensation Laws
Workers’ compensation is designed to protect both employees and employers. When a worker is injured on the job, they can receive benefits for medical care, lost wages, and rehabilitation. In exchange, the worker generally cannot sue their employer for negligence. However, this system only works when employers and insurance companies follow the law and that doesn’t always happen.
In Louisiana, employers are required by law to carry workers’ compensation insurance if they have even one employee. This coverage applies to almost every worker, including full-time, part-time, and seasonal employees. When an injury occurs, your employer must report it to their insurance carrier and file a First Report of Injury with the state.
Unfortunately, some employers and insurance companies try to avoid paying benefits by disputing or denying valid claims. While not every denial is illegal, many are made without proper justification or in violation of Louisiana workers’ compensation laws.
When Employers Can Legally Deny a Claim
There are certain situations where a workers’ compensation claim can be legally denied. The key factor is whether the claim meets the state’s requirements for eligibility. Under Louisiana law, your employer or their insurance carrier may have legal grounds to deny your claim if:
- The injury was not work-related: Workers’ comp only covers injuries that occur while performing job duties. If your injury happened off-site or during a personal errand, your claim may be denied.
- The injury was not reported on time: You must report a workplace injury to your employer within 30 days of the accident. Failing to meet this deadline could result in a valid denial.
- There is insufficient medical evidence: You need medical documentation linking your injury to your job duties. If you didn’t see a doctor or didn’t follow up with treatment, your employer might challenge the claim.
- Misconduct was involved: Claims may be denied if the injury occurred because of intoxication, fighting, or intentional self-harm.
- You were not classified as an employee: Independent contractors and certain subcontractors may not be covered under your employer’s policy.
In these situations, the denial may be justified under Louisiana law. However, many claims are rejected for reasons that do not hold up under legal scrutiny and that’s where an experienced workers’ compensation attorney can make a difference.
When a Workers’ Comp Denial May Be Illegal
Some employers deny claims not because they are invalid, but because they are trying to save money or avoid higher insurance premiums. In other cases, insurance companies use tactics to delay or minimize payments. These actions can violate state law and your right to fair treatment under the Louisiana Workers’ Compensation Act.
Examples of potentially illegal or bad-faith claim denials include:
- Denying without proper investigation: Your employer must review your injury report and medical records before rejecting a claim. Denying without a fair investigation may violate the law.
- Claiming your injury was “pre-existing” without medical proof: Insurance companies often use this excuse to avoid paying, but without credible evidence, this can be challenged.
- Delaying payment of approved benefits: Once your claim is accepted, payments must be made promptly. Unreasonable delays may constitute bad faith.
- Misclassifying employees: Some employers mislabel workers as independent contractors to avoid paying benefits. This practice is illegal in Louisiana.
- Retaliation for filing a claim: It is against the law for an employer to fire, demote, or discipline you for reporting a workplace injury or filing for workers’ compensation.
If your employer or their insurance company has denied your claim for any of these reasons, you have the right to challenge the decision and pursue the benefits you are owed.
How to Appeal a Denied Workers’ Compensation Claim in Louisiana
Just because your claim was denied doesn’t mean the fight is over. You have the right to appeal the decision through the Louisiana Office of Workers’ Compensation Administration (OWCA). The process begins by filing a Disputed Claim for Compensation (Form 1008).
Once the form is filed, your case will be reviewed by an administrative law judge who will consider evidence from both sides. This may include medical reports, witness statements, accident records, and testimony. Having an experienced workers’ compensation attorney represent you during this process greatly improves your chances of success.
At Wanko Workers’ Comp Lawyers, we regularly handle appeals for injured workers whose valid claims were unfairly denied. We understand how to gather strong evidence, challenge improper denials, and present persuasive cases before the OWCA.
Why You Shouldn’t Face a Denial Alone
Workers’ compensation laws are complex, and employers often have legal teams working to protect their bottom line. Trying to fight a denied claim on your own can be overwhelming, especially when you’re recovering from an injury and struggling financially. An attorney who understands Louisiana workers’ compensation law can step in to level the playing field and protect your rights.
Your lawyer can:
- Review your claim and determine whether the denial was legal
- Gather additional medical or witness evidence to strengthen your case
- File all necessary appeal paperwork and represent you at hearings
- Negotiate with insurance adjusters for a fair settlement
- Ensure you receive the full benefits you are entitled to under Louisiana law
When your benefits are denied, time is critical. The sooner you speak with an attorney, the more options you’ll have to fight back and secure the compensation you need to recover.
Contact Wanko Workers’ Comp Lawyers in Thibodaux
If your employer or their insurance company has denied your workers’ compensation claim, don’t assume the decision is final. You may still have a strong case for benefits and you don’t have to face it alone. At Wanko Workers’ Comp Lawyers, we help injured workers throughout Louisiana appeal denials, prove eligibility, and recover the medical and wage benefits they deserve.
To learn more about your options, contact us today for a free consultation. We’ll review your case, explain your rights, and take action to help you get back on your feet.
